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Salmonella bacteraemia in children with sickle cell disease
  1. G Hann1,
  2. M Roberts-Harewood2,3,
  3. D A Yardumian3,
  4. O Wilkey1
  1. 1Paediatric Department, North Middlesex University Hospital NHS Trust, London, UK
  2. 2Paediatric Haematology Department, Great Ormond Street Hospital, London, UK
  3. 3Haematology Department, North Middlesex University Hospital NHS Trust, London, UK

Abstract

Background It is well recognised that individuals with sickle cell disease (SCD) are more susceptible to salmonella infection. Children infected with salmonella are prone to developing multisystem infection such as osteomyelitis, liver and splenic abscesses, and overwhelming sepsis sometimes with fatal consequences.

Objectives Using a case series, we aim to highlight the invasive and virulent nature of salmonella and demonstrate the whole range of potential complications with a strong emphasis on the importance of prevention. We advocate early and aggressive management of salmonella infection, to maximise treatment efficiency and reduce complications.

Methods A retrospective case notes review of patients who attended a London tertiary sickle cell centre, between 2006 and 2011 was performed in children with reference laboratory confirmed salmonella enteritidis, salmonella paratyphi B, salmonella Thompson or salmonella typhi bacteraemia. We describe their clinical presentation and chronological course of their illness, relevant investigation results, imaging, management and outcome. Important learning points will be highlighted.

Results 8 children with salmonella bacteraemia suffered severe complications such as stroke, osteomyelitis, chest crisis, liver and splenic abscesses and in two cases overwhelming sepsis resulting in death, emphasising the need for early recognition and therapeutic intervention in all cases.

Conclusions Salmonella bacteraemia can have catastrophic consequences in patients with sickle cell disease. Presently, aggressive treatment with antibiotics and early recognition of complications are the mainstay of management. Additionally, health promotion strategies to prevent infection play an important role. We conclude more research needs to be carried out on the effectiveness of vaccines to prevent salmonella infection in children with sickle cell disease.

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